Febrile Illness Unmasks Brugada Syndrome

The Brugada syndrome is characterized by right bundle-branch block pattern on Electrocardiogram (ECG), right precordial ST-segment elevation [usually leads V1/V2] and syncope/sudden cardiac death in absence of significant electrolyte abnormalities, ischemia or structural heart disease [1]. A 59 year old presented with dizziness and fever due to pyogenic liver abscess. Multiple ECG’s during the hospital admission revealed a Brugada type 1 pattern. The ECG reverted to normal when fever resolved. Mutations in the cardiac sodium-channel gene SCN5A which cause a decrease in the inward depolarizing sodium current have been associated with the Brugada syndrome [2-4]. The dysfunction of the sodium channel is exaggerated at higher than physiologic temperatures; the syndrome may be unmasked by fever increasing the risk of ventricular arrhythmias and/or sudden cardiac death [5-8]. The association of febrile illness with the potential for life-threatening cardiac events, heralded by unique electrocardiographic abnormalities, should be recognized.